Get the latest regulatory updates and learn about the future of member accounting and reconciliation at the virtual conference June 29-30.

Here’s a look at 10 sessions we plan for the two-day live-streaming event:

Enrollment and encounters reconciliation

David Meyer, a long-time member of the RISE Executive Committee, will provide a big picture overview of the membership pipeline from application to Centers of Medicare & Medicaid Services (CMS) approval, enrollment and encounter issues for Dual Eligible members, D-SNPs, and DUAL D-SNPs, as well as enrollment accuracy.

Leveraging technology to send accurate data to CMS

Join Kwame Appiah-Yeboah, director, risk adjustment & revenue management, Sentara Health Plans, to learn how to ensure your data is complete and accurate. Appiah-Yeboah will explain how CMS acquires the data and the risks of inaccuracy and will help attendees identify errors and uncover fraud prior to CMS submissions.

Part D reconciliation 101

Learn how to optimize your Part D reconciliation process. Sarah Dixon, 
senior director, Kelsey-Sebold Clinic, will help attendees identify key differences in claims and tips for direct and indirect remuneration (DIR) protocols, how changes to point of sales regulations may impact your bottom line, and the practical details of everything from prescription drug event reconciliation to pharmacy benefits manager oversight.

Part C reconciliation 101

Prateek Arora, AVP of product systems innovation, Visiting Nurse Service of New York, will offer takeaways to build out an overarching role and strategy for your CMS revenue process. Arora will explain the key levers used for revenue projections during the Medicare bid, offer best practices for risk score management, and will cover everything from end-to-end flowchart to mid-year and final year sweeps. Attendees will also receive best practices and the impact of quality STARs on health plan revenue.

Legal basics on Medicare Secondary Payer (MSP)

Rafael Gonzales, partner, Cattie & Gonzales, PLLC, will go over Medicare Trust Funds and CMS’ MSP mandates, MSP for Group Health Plans (GHP), MSP develops for injury coverage/non-group health plans and the Provide Accurate Information Directly (PAID) Act.

MSP best practices and tools

Join Brian Bargender, management consultant, subrogation and other payer liability, Humana, to better understand MSP data files that CMS provides to Part C and Part D plans, file validation for GHP records, and payment avoidance and recovery from primary payers.

Changing regulatory and legislative environments

Review the Final Rate Notice and Final Technical Rule and learn what to expect with new CMS regulations in CY 2023 and beyond. Speakers will also provide a legislative overview and update. Presenters include Aldiana Krizanovic, senior health policy consultant, Blue Cross, Blue Shield Florida, and Howard Weiss, VP, public policy & government affairs, Emblem Health.

Coordination of benefits: Financial reconciliation for revenue accuracy and recovery

This session will explain how to determine end-to-end coordination of benefits to help streamline your options for maximum revenue recovery. Speaker Sherri Murray-Richardson, director, Anthem, will also provide a deep dive into the monthly membership report (MMR) Reconciliation and Electronic Correspondence Referral System (ECRS) translation process and help ensure you receive the right reimbursements for drug costs through End Stage Renal Disease (ESRD) validation and transplant costs.

The future of accounting and reconciliation

Gonzales and Murray-Richardson will turn for a presentation to help you grow your market share post-COVID. They’ll discuss how to achieve faster speed-to-market times with new products, how to use incentives, gamification, and other strategies to ensure members prioritize their wellness, calculate and adjust for lifetime values of members, and navigate the mergers and acquisition landscape.

Reconciliation processes across value-based contracts

This session will look at how risk bearing ACOs and medical groups should manage and provide oversight to the flow of data between them, payers, and/or the government. Speakers will include Meyer and Misty Allen, director, quality & risk adjustment.

The virtual 2022 Medicare Advantage Member Accounting and Reconciliation Summit will take place June 29-30. Click here for more information about the live-streaming event, including the full agenda, list of speakers, and how to register.